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More Twist and Still More Pumping Measures Waiting in the Wings
The June FOMC meeting was the first in which the two new members of the board of governors (the 7-headed hydra in Washington the members of which have a permanent vote on the FOMC), Jeremy Stein and Jerome Powell took part.
It is quite funny in hindsight that the Republican Congress refused to confirm several previous candidates to these posts on the grounds that they were 'old style Keynesians' or otherwise suspected of being prone to leaning toward more easy money.
As it turns out, the two new appointments which eventually found favor with these Congressional defenders of monetary rectitude are among the board's most dovish members. This was gleaned from the projections of board members regarding the speed with which they expected monetary tightening to become necessary.
The WSJ reports in this context:
" Both new Fed board members—Democratic economist Jeremy Stein and Republican businessman Jerome Powell—appear to be in Chairman Ben Bernanke's more dovish camp. Notably, the Fed's projections showed that an additional two board members don't expect the Fed to tighten policy until 2015."
If Japan's experience over the past two decades is any indication, even that estimate will prove to be wide of the mark.
As was widely expected, the FOMC decided to extend its 'Operation Twist', although one wonders what for. With the 10 year treasury note yield close to all time lows, what is to be gained from this?
On the other hand it was difficult at this time to engage in more foreceful monetary pumping measures. There are political headwinds that require the Fed to come up with a very good excuse if it wants to start 'QE3'. Such an excuse would be provided by a sharp fall in the stock market, or a noticeable further deterioration in economic data.
So what is the extension of the relatively useless 'Twist' program telling us? It says: we want to print. Even if we can't go whole hog yet, we'd rather do something that is useless even from our own point of view, rather than doing nothing.
This was further buttressed by the changes in the FOMC statement and its altered economic outlook. Well-versed Kremlinologists at the WSJ have constructed a 'Fed statement tracker' that allows one to parse the FOMC statement in detail and see the changes relative to the previous statement at a glance. As can be seen, there are a number of notable differences this time around, all reflective of a downgrade of the Fed's economic forecast and hence hinting at more monetary pumping down the road.
The economic forecasts and estimates regarding the future path of policy of individual board members can be seen here (pdf).
Widely Accepted Fallacies
During the press conference, Bernanke was once again frequently asked 'why isn't the Fed doing more right away'. After all, its statement and forecast indicate that is expects no further improvement in the labor market for the rest of the year. There are no journalists at that press conference who doubt the wisdom of central planning or have the slightest suspicion that more money printing could be anything but a boon for the economy. This is the level to which the discourse on monetary matters has regrettably sunk nowadays. It is assumed as a matter of course that if only enough money were printed, the economy would surely get better.
Bernanke's replies to these questions all hinted at his willingness to do just that. We strongly suspect that among the reasons why the FOMC has not yet decided on more forceful pumping measures in the form of 'QE3' or something akin to it there is not only the current political difficulty of doing so.
There is also the fact that there is at the moment no real crisis in the US financial markets and economy. However, there is a crisis in the euro-area, and the danger that it could migrate and trigger crises elsewhere is great. So if the FOMC were to embark on 'QE3' right now, the question would then be:
How to top that if a real crisis were to strike, with the stock market crashing and interbank markets freezing up again?
Moreover, Bernanke pointed to some of the limitations faced by the Fed. For instance, 'QE2' removed a large amount of treasury bonds from the marketplace. However, it is precisely these treasury bonds that are the favored collateral in repo transactions. There is at present a 'shortage' of AAA rated assets that can be used for such transactions. Obviously, the higher rated the collateral, the smaller the haircuts and margin requirements demanded by liquidity providers. The Fed's 'QE' operations were both accompanied by big spikes in 'fails to deliver' in the treasury market. There can be no doubt the Fed is well aware of this.
There is of course something quite perverse about a financial system that requires government debt of all things to function properly, especially considering that this debt has grown to truly monstrous proportions.
The bigger the role of government in the economy, the more wealth is destroyed. A productive loan that is invested in new capital to increase production or start a new line of production with the aim of satisfying consumer wants increases wealth (leaving aside that due to the uncertain future a certain percentage of productive lending will come to grief).
A loan to government is not based on such a prospective increase in wealth to ensure payback, but on its opposite.
The government merely promises its lenders: "we will either confiscate someone's wealth to pay you back or simply print the money – or both". Obviously neither of these methods is likely to grow society's wealth. And yet, these certificates of confiscation have become an important pillar underpinning the modern-day financial system.
The idea that the Federal Reserve can improve our economic lot by printing more money is an analogous fallacy – just as more government spending is a burden rather than a boon for the economy, so the printing of more money can not add anything to our wealth. It is the production of goods and services that increases wealth. Printing additional money tokens (or creating their electronic equivalent in cyberspace) is only apt to distort relative prices and will therefore lead to capital malinvestment. And yet, listening to Mr. Bernanke's press conference and the questions asked of him, one comes away with the impression that absolutely no-one in the financial press doubts that we can print ourselves rich.
Hawks Outnumbered
One thing the financial press has however without a doubt gotten right is that the extension of 'Operation Twist' is merely an opening gambit before additional pumping measures are announced.
"It is unlikely that the Federal Reserve's efforts to boost the economy will end with "Operation Twist."
The Fed's rate-setting committee decided Wednesday to extend its so-called Twist operations. These involve it selling short-term Treasuries and using the funds to buy long-dated ones. The goal is to bring down long-term interest rates.
The extension of Twist assuaged markets, which had expected action along those lines. But the Fed also lowered the bar for further efforts, noting in its statement that it was ready to do more to promote "a stronger economic recovery and sustained improvement in labor-market conditions." And, in projections released shortly afterward, the Fed said the central tendency of board members' year-end unemployment estimates ranged from 8% to 8.2%, versus the 7.8% to 8% they expected in April. The unemployment rate last month was 8.2%.
So, to sum it up, the Fed wants a better job market. And the Fed doesn't think that the job market is going to show much, if any, improvement through the end of the year.
Absent a turn for the better between now and the Fed's two-day meeting July 31 and Aug. 1, it looks as if more action could be in the offing. That would likely involve a third round of quantitative easing, or QE3, involving outright purchases of Treasuries and, especially, mortgage-backed securities.
The hawks on the Fed will complain, and with rates at rock-bottom levels already, the efficacy of further action is indeed open to debate. But they are now more outnumbered than ever.
(emphasis added)
As to the 'hawks' at the Fed, all of them are district presidents who don't have a permanent FOMC vote. Furthermore, there are so few of them that one can count them on the fingers of one hand. They are Jeffrey Lacker (Richmond Fed), Richard Fisher (Dallas Fed), Charles Plosser (Philadelphia Fed) and to a lesser extent Nayarana Kocherlakota (Minneapolis Fed). Only Jeffrey Lacker has an FOMC vote this year, and he has been the lone dissenter in all decisions so far taken this year. With two new 'doves' added to the board of governors in Washington, it is indeed a good bet that all the grumbling of the 'hawks' will be for nought.
An important additional point worth mentioning with regards to the Fed's economic forecast is that it not only sees unemployment remaining very high, it also has lowered its 'inflation' estimates considerably (i.e., its estimates of the future increase of the 'general price level' as measured by CPI and/or PCE). This is important because it creates the intellectual wiggle room for further monetary easing. One question Bernanke fielded during the press conference was whether he wouldn't agree that 'QE2' failed to produce any of the desired effects. His reply was revealing – he essentially conceded that the results were somewhat disappointing, but asserted that it was still worth doing. The reason: it helped 'avert the danger of deflation'.
Market Reaction
Nonetheless, the financial markets were less than happy with the FOMC announcement. Both stocks and commodities, including gold have trended lower ever since, although the stock market attempted a comeback late in the day yesterday. It appears the markets had primed themselves for a 'QE3' type announcement and since that was not forthcoming, sellers merged. This is slightly mysterious to us – it should have been clear to market participants that no such announcement would be forthcoming at this particular FOMC meeting. There simply was no justification for taking such a step now and the Fed doesn't want to become the center of attention in an election year – it may well be accused of trying to influence the election, a charge it is no doubt eager to avoid (as a matter of fact, such an allegation would not have any merit anyway in our opinion, but this is beside the point).
The SPX intra-day yesterday: first elation, then disappointment, then a small comeback attempt – click chart for better resolution.
SPX – the first 90 minutes of trading today – selling resumes – click chart for better resolution.
The past five trading days in gold (including the first half of today's trading) – whatever enthusiasm there was – and as we have pointed out there wasn't much to begin with – has gone out of it again. The consolidation/correction continues for now – click chart for better resolution.
Crude oil also continued to fall on very high trading volume – click chart for better resolution.
As can be seen, the markets these days only rally when there is a firm commitment to more money printing. 'Twist' influences bond yields at the long end of the curve, but it does not add to the money supply.
Charts by: BigCharts, StockCharts, Comdirect
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|Número de publicación
|Tipo de publicación
|Número de solicitud
|Fecha de publicación
|19 Ago 2004
|Fecha de presentación
|13 Feb 2003
|Fecha de prioridad
|13 Feb 2003
|Número de publicación
|Erik Martz
|Cesionario original
|Osteotech, Inc.
|Exportar cita
|BiBTeX, EndNote, RefMan
|Citas de patentes (12), Citada por (39), Clasificaciones (8), Eventos legales (1)
|Enlaces externos: USPTO, Cesión de USPTO, Espacenet
[0001] 1. Field of the Invention
[0002] The invention relates to a guide and end plate preparation instrumentation system configured to prepare opposing end plates of adjacent vertebrae so as to form a pocket, shaped and dimensioned to correspond to the shape and dimensions of the selected spinal implant.
[0003] 2. Background of Related Art
[0004] The spine is a flexible column formed of a series of bones called vertebrae. The vertebrae are hollow and piled one upon another, forming a strong hollow column for support of the cranium and trunk. The hollow core of the spine houses and protects the nerves of the spinal cord. The different vertebrae are connected together by means of articular processes and intervertebral, fibro-cartilages.
[0005] The intervertebral fibro-cartilages are also known as intervertebral discs and are made of a fibrous ring filled with pulpy central material. The discs function as spinal shock absorbers and also cooperate with synovial joints to facilitate movement and maintain the flexibility of the spine. When one or more discs degenerate through accident, spondylolisthesis or other pathologies, nerves passing near the affected area may be compressed and are consequently irritated. The result may be chronic and/or debilitating back pain. Various methods and apparatus, both surgical and non-surgical, have been designed to relieve such back pain.
[0006] One method designed to relieve such back pain is interbody spinal fusion. Typically, interbody spinal fusion involves distracting adjoining vertebrae of the spine so that the nerve root canal sizes are increased and nerve irritation is eliminated or reduced. In order to maintain the adjoining vertebrae of the spine in a distracted state, at least one intervertebral implant is inserted into a receiving bed formed between the vertebrae. The implant is positioned to engage the adjoining vertebrae to maintain the vertebrae at a fixed degree of distraction. Preferably, the implant should stabilize the intervertebral space and become fused to adjacent vertebrae in order to prevent the implant and adjacent vertebrae from moving.
[0007] A variety of different types of intervertebral implants have been developed to perform this function including spinal fusion cages, threaded bone dowels, stepped bone dowels and wedges.
[0008] In order to install these implants the disc space and often the faces of the end plates of the adjacent vertebrae need to be prepared to receive the implant by removal of disc material and/or forming a bed in the faces of the end plates. These operations are typically carried out by an operating surgeon making decisions based on his/her experience. Accordingly, in a large number of instances, the opposing end plates defining a pocket therebetween are not uniformly shaped, and thus may not be placed in the desired spatial relationship, which should correspond to the known shape of the selected spinal implant.
[0009] Accordingly, a need exists for a system of instrumentation and a surgical method for advancing, positioning and operating end plate preparation instruments so as to create an implantation disc space provided with a shape and dimensions corresponding to the selected shape and dimensions of the selected implant
[0010] Consonant with the above-formulated objective, an instrumentation system for preparing end plates of adjacent vertebrae to be fused includes a frame, insertable into a distracted disc space defined between adjacent end plates, and end plate preparations instruments displaceable into the disc space along a uniform path defined by the frame. The uniform path allows multiple end plate preparation instruments including, but not limited to, chisels and rasps, to be so oriented within the disc space that the opposing end plates of the vertebrae to be fused are aligned in the desired spatial position. The inventive system and method eliminate free hand motions to form the disc space characterized by the precise size, shape and configuration, as well as to make the extent of the vertebral endplate resection predictable, precise and reproducible, if necessary.
[0011] Thus, the primary advantage of the present inventive system is its ability to uniformly prepare the opposing end plates of the adjacent vertebrae to be fused in the desired anatomical conformation leading to the formation of the disc space corresponding to the selected shape of the spinal implant. As a result, the inventive system allows for the maximum stability of the selected spinal implant, as well as the construct, by providing for the optimal interface surface area and congruency between the implant and each of the opposing end plates of the vertebrae to be fused.
[0012] According to one aspect of the present invention, the frame is configured with a combination of stops preventing uncontrollable penetration of the end plate preparation instruments into the disc space, as well as determining a desired engaging position of the frame and the adjacent vertebrae. The geometry of the frame allows the stops to be placed at strategic locations along the paths of the frame, displaceable relative to the vertebrae, and to controllably stop displacement of the frame and the instruments into the disc space. In addition to the stops, this aspect of the invention is concerned with a guide assembly provided between the frame and the end plate instruments and defining a desired path of the end preparation instruments into and out of the disc space.
[0013] Accordingly, one of the advantages of the inventive instrumentation system is that it can be selected and calibrated for the maximum safe penetration depth of the frame into the disc space and for locking the instruments at the desired depth so as to prevent unwanted over penetration of these instruments.
[0014] A further aspect of the invention is directed to a modular structure of the frame configured to be piecemeally disassembled in its inserted position within the treated disc space to facilitate subsequent insertion of a spinal implant. While different combinations of frame components can be removed from the disc space, the remaining component(s) of the frame would still maintain the disc space as prepared by the end plate instruments.
[0015] Still another aspect of the invention includes a variety of end preparation instruments each provided with a structure that cooperates with the inventive frame to shape the end plates so that they would be in desired alignment. In particular, the structure of the inventive end plate preparation instruments is configured to have guide surfaces mating with the guides and stop formations of the frame so that the end plates are prepared to define therebetween an implant receiving pocket formed with the desired length and depth.
[0016] A further aspect of the invention relates to a surgical kit including the inventive frame, end plate preparations instruments, specifically configured to cooperate with the frame, and a plurality of implants of different sizes and shapes. In addition, the kit may include a combination of actuating elements, such as various tools and implant holders as well as slap hammers facilitating the removal of the inserted system components from the disc space.
[0017] It is an object of the invention to provide an instrumentation system for use in spinal surgery configured to advance, position and operate a plurality of end plate preparation instruments so as to create the implantation space of the selected shape and dimensions corresponding to those of the known implants.
[0018] Another object of the invention is to provide a guide including a frame, which is configured, to be inserted into the distracted disc space so as to provide for the controllable advancement of the end plate preparation instruments into the disc space.
[0019] Still another object of the invention is to provide the frame having a modular structure configured to allow variously shaped and dimensioned spinal implants to be inserted between the prepared end plates.
[0020] A further object of the invention is to provide a set of end plate preparation instruments configured to cooperate with the frame and shaped to controllably deepen and elongate the distracted disc space.
[0021] Another object of the invention is to provide a kit including a combination of instrument guides and end plate instruments configured in accordance with the invention.
[0022] The above and other objects, features and advantageous will become more readilly apparent from the following specfic description dsiclosed in conjunction with a set of drawings, in which:
[0023]FIG. 1 is a perspective view of an instrumentation system configured in accordance with the invention and shown in a deployed position of a chisel;
[0024]FIG. 2 is an isometric view of an end plate preparation instrument;
[0025]FIG. 3 is a perspective view of an end plate praparation instrument guide of the instrumentation system shown in FIG. 1;
[0026]FIG. 4 is a top plan view of the instrument guide of FIG. 2;
[0027]FIG. 5 is an end view of an end plate preparation instrument of FIG. 2;
[0028]FIG. 6 is an exploded perspective view of the instrument guide of FIG. 2 having a modular structure;
[0029]FIG. 7 is an exploded perspective view of the instrumentation system configured in accordance with another embodiment of the invention;
[0030]FIG. 8 is a side view of a slap hammer for use with the instrument guide of FIGS. 3 and 8. indicia
[0031]FIG. 9 is a perspective view of another inventive embodiment of the chisel guide; and
[0032]FIG. 10 is perspective view of an end plate preparation instrument configured for use with the chisel guide of FIG. 9.
[0033] The present disclosure relates to various embodiments of an instrumentation system for use in intervertebral implant procedures directed to preparation of a pocket defined between end plates of adjacent vertbrae A and B and configured to receive a spinal implant. Referring initially to FIGS. 1-5, and particualrly to FIG. 1, the instrumentation system includes an instrument guide 10, configured to be inserted into a disc space C between opposing end plates of the adjacent vertebrae A and B, and an end plate preparation instrument 50 displaceable along the the guide 10 into the disc space C.
[0034] The inventive instrumentation system provides for controllable penetration of the instrument guide 10 and the end plate preparation instrument 50 into the disc space C along the desired uniform path of the end plate instruments. Accordingly, the end plate preparation instruments remove the same amount of material from and apply the uniform shape to the opposing upper and lower end plates of the adjacent vertebrae A and B. Hence, the disc space, thus prepared, conforms to the selected shape of the known spinal implant, which is critical to the safe and successfult outcome of the spinal surgery. The following discussion will be directed to the end plate preparation instrument 12 which, for purely illustrative purposes, includes a chisel. However, other end plate preparation instruments can be used in combination with the instrument guide 10, provided these instruments are configured so as to cooperate with the guide's strcuture in a controllable manner limiting the instruments' penetration into the disc space along the desired path defined by the guide.
[0035] Referring now to FIG. 2, the chisel 50 includes a front portion 52 configured to be inserted into the disc space C and a handle portion 54 extending rearwards from and having a thickness larger than a thickness of the front portion 52. Accordingly, the front 52 and handle 54 portions of the chisel 50 define therebetween a rear stop 56 configured to abut an outer surface 8 (FIG. 1) of either upper A or lower B vertebra to prevent uncontrollable penetration of a cutting edge 58 of the chisel 50 into the disc space. Spaced frontward from the rear stop 56 is front stops 60 configured to abut formations on the instrument or chisel guide 10 to ensure that the cutting edge 58 would not advance into the disc space father than a depth required by the dimensions of the selected spinal implant. Other configurations of the front stops 60 are envisioned and may include, for example, instead of two spaced stops, a continuous front stop. A height of the stop(s) 60 cooperating with a depth of chisel guide 10, as will be explained further, determines the appropriate amount of depth of cut into the vertebrae.
[0036] Turning to FIGS. 3-5, the chisel guide 10 generally includes a frame provided with a center shelf 12 and a pair of opposing sidewalls 14 and 16. A forward wall 18 extends between the distal ends of sidewalls 14 and 16. Preferably forward wall 18 has an arcuate shape facilitating insertion of chisel guide 10 between adjacent vertebrae. The combination of center shelf 12 and sidewalls 14 and 16 define a cumulative depth D of two pockets formed in the upper and lower end plates, respectively, and substantially corresponfing to the height of the sidewalls, and a width W, corresponfing to a distance between the inner sides of the sidewalls, which is selected to receive the chisel 50. Chisel guide 10, as illustrated in FIGS. 3-5, is monolithically formed of material such as stainless steel.
[0037] Sidewalls 14 and 16 are provided with upper and lower stops 20 and 22, respectively, (FIG. 5) at proximal ends of the sidewalls. Stops 20, 22 can have spikes 23, formed either integrally therewith or mounted on the stops through holes (not shown) after the guide 10 is fully inserted onto the disc space. The spikes are configured to penetrate the vertebrae and secure the chisel guide to the vertebrae. Stops 20 and 22 function to engage the outer surface 8 (FIG. 1) of the vertebrae and limit the depth of insertion of chisel guide 10 between the adjacent vertebrae. Sidewall 14 has an upper vertebral supporting surface 24 and a lower vertebra-supporting surface 26, whereas sidewall 16 has an upper vertebral supporting surface 28 and a lower vertebral supporting surface 30. Forward wall 18 has a chamfered nose extending between edges 32 and 34. Upper supporting surface 24 and lower supporting surface 26 of sidewall 14 as well as upper supporting surface 28 and lower supporting surface 30 of sidewall 16 are configured to engage and support adjacent vertebrae in a distracted condition during the entire chiseling operation. The edges 32 and 34 of forward wall 18 only support the adjacent vertebrae during initial insertion and cutting of the chisel 50. Thereafter, the disclosed chisel will extend above and beyond upper edge 32 or lower edge 34 of forward wall 18 depending upon which vertebrae is being cut.
[0038] Preferably, chisel guide 10 includes upper and lower stops 36, at the intersection of sidewall 14 and forward wall 18 and upper and lower stops 38 formed at the intersection of sidewall 16 and forward wall 18. Stops 36 and 38 are provided to selectively engage the front stops 60 on the chisel 50, depending upon which vertebrae is being treated, and to limit the depth of penetration of the chisel within the vertebral disc space. Center shelf 12 includes an upper guiding surface 40 and a lower guiding surface 42 to provide a platform against which the chisel 50 can slide. As shown in FIGS. 4 and 5, chisel guide 10 further includes a bore 46 formed in a proximal edge of shelf 12 for receipt of an insertion tool. The bore 46 may or may not be threaded depending on the structure of the insertion tool.
[0039] In order to provide room for chisel guide 10, adjacent vertebrae A and B, defining therebetween the collapsed disc space C, need to be forced apart or distracted by a distractor typically having a distraction head and a shaft extending therefrom. The distractor is inserted between vertebrae A and B and force or wedge apart vertebrae A and B. This can be done in a single step or with multiple distractors serially distracting from smaller to larger heights until the appropnate tension between the adjacent vertebrae is achieved. Insertion of the distractor continues until the distraction head is fully seated between the adjacent vertebrae at the desired height. Incidentally, the chisel guide 10 can be used as a distractor by gradually introducing the front, generally frustoconical forward wall 18 between the adjacent vertebrae, which, thus, are displaced away from one another to reach the depth D of the guide defined between opposite supporting surfaces 24, 26 and 28, 30 (FIG. 3).
[0040] Turning to FIG. 6, to insert chisel guide 10 between the now distracted vertebrae, an insertion tool 70 having a threaded pin 72 is attached to chisel guide 10 by threading in the pin 72 into threaded bore 46 (FIG. 5). In response to a thrust generated by the operator, insertion tool 70 advances chisel guide 10 into the distracted disc space C at the depth of penetration defined by rear stops 20 and 22 of the chisel guide 10 engaging the outer surface 8 (FIG. 1) of the adjacent vertebrae. The stops 20, 22 are so located that the chisel guide 10 is fully inserted between the adjacent disc space when the stops abut this outer surface of the vertebrae, after which insertion tool 70 can be unthreaded.
[0041] At this point, as illustrated in FIG. 1, the chisel 50 is introduced into the upper or lower compartment of the chisel guide 10, each of which is defined between the forward wall 18, side walls 14 and 18 and either upper 40 or lower 42 guiding surface of the shelf 12. The chisel 50 and the compartments are configured so that the front portion 52 of the chisel is slidingly guided by respective surfaces of the sidewalls 14, 16 and the shelf 12 of the chisel guide 10 without deviations from the desired path. Accordingly, since the paths along the upper and lower compartments are identical and the shelf 12 extends substantially midway between the opposing end plates, the chisel 50 removes substantially the same amount of material from the end plates each of which is, thus, prepared with a substantially identical pocket. Accordingly, the disc space has the desired shape and dimensions corresponding the shape and dimensions of the selcted implant. The inner surfaces of the sidewalls 14, 16 and opposing outer surfaces of the chisel 50 may have variously shaped detents and projections 78 (FIG. 7) slidingly engaging one another to even further ensure the uniformity of the path along which the chisel guide 50 slides relative the guide 10. Furthermore, each of the sidewalls 14 and 16 may be formed with a dovetail shape necessitating the slanted sides of the chisel 50. The chisel guide could also be hollow; i.e., its shelf could have a window to allow for passage of debris during endplate preparation. This debris could then be removed on the underside of the guide.
[0042] Advancement of the chisel 50 into the disc space continues until front the stop(s) 60 engage the upper or lower stops 36, 38 and/or the rear stop 56 engages the outer surfaces 8 of the vertebra to prevent any further insertion of chisel 50 into the disc space C. Once one of the lower or upper vertebra has been cut and its end plate prepared, chisel 50 can be removed and reinserted to cut the other vertebra in similar fashion.
[0043] The prepared disc space includes pockets formed by removing the substnatially uniform amount of material in both the upper vertebrae and lower vertebrae. Note that the geometry of the chisel 50 allows the cutting edge 58 to extend beyong the forward side 18 of the shisel guide 10 while the upper 24, 28 or lower 26, 30 supporting surfaces of the sidewalls 14, 16, respectively, support the adjacent end plates of the vertbrae A and B. Accordingly, since the length of the cut in the vertebrae extends beyond the distal end of chisel guide 10, the upper supporting surface 32 and lower supporting surface 34 of forward wall 18 no longer support the adjacent vertebrae as the material has been cut away beyond this ledge of chisel guide 10.
[0044] Once the chiseling operation has been completed, insertion tool 70, as seen in FIG. 6, can be used to remove the chisel guide 10 from the disc space. It may be useful to provide a slap hammer 80 as shown in FIG. 8 to facilitate withdrawal of chisel guide 10 and attached insertion tool 60. Slap hammer 80 generally includes an elongated shaft 82 having an end cap 84 threaded on a proximal end thereof. Attachment structure 86 is provided at a distal end of shaft 82 and is configured to engage proximal end of the insertion tool 70. A movable weight 88 is provided between the proximal distal ends of slap hammer 80 so as to facilitate withdrawal of insertion tool 60 by forcing weight 88 approximately against end cap 84. Upon removal of at least part of the guide 10, the prepared end plates have a contour and dimesnions conforming to thise of the selected spinal implant.
[0045] Referring then to FIG. 7, there is illustrated a modular structure of the chisel guide 10 having the first component consisting of center shelf 102, the second component including sidewall 104 and the third component consisiting of another sidewall 106. The sidewalls 104 and 106 are removably attached to center shelf 102. Thus, guide tool 10 is provided with three separable components each of which, once the appropriate cuts have been made in the adjacent vertebrae, may be selectively removed from the prepared disc space C position. At least one of the side walls 104, 106 may remain within the disc space to maintain the appropriate spacing and distraction of the adjacent vertebrae A and B.
[0046] Center shelf 102 includes a bore 108 for receipt of an insertion tool and similarly sidewall 106 includes a bore 112 for receipt of a similar insertion tool. Each of the sidewalls 1104, 106 includes a projection 114 which is configured to engage slot 116 fromed in the sidewalls of the center shelf 102. The location of the prjections and slots can be reversed so as to have the shelf 12 formed with projections 114 engaging the slots 116, which would be formed on the sidewalls 104, 106. Preferably, the projections and slots 116 are of the dovetail variety. Insertion tool 70 (FIG. 6) can be selectively inserted in bores 108, 112 of center shelf 102 and sidewalls 104 and 106, respectively, to remove any of these from between the adjacent vertebrae. The side walls would be placed first, by inserting them in their "small" state and then rotating them 90 degrees until they are in the orientation shown in FIG. 7, then the center piece 102 would be inserted. The side pieces can have means to attach other inserter/handles that allow for translational insertion plus rotation into final position. Alternatively, the guide may be formed as a two part chisel guide consisting of a center shelf 102 and one of the sidewalls 104, 106 fromed integrally with the shelf. In a still another alternative configuration of the ebntire system, the stops 36, 38, located on the shelf 102, can be formed on the inner surfaces of the sidewalls 104, 106.
[0047] In use, once the end plate is shaped and dimensioned as desired, the shelf is removed freeing a sufficient space to insert the implant between the sidewalls, which, in turn, can be removed after the implant is properly positioned. Either of the sidewalls may removed simultanoeusly with the shelf 102 to provide additional clearance for insertion of the selected implant.
[0048] Referring now to FIGS. 9-10, there is illustrated further embodiment of a chisel guide 150 and an associated chisel 162 for use in forming and preparing end plates of adjacent vertebrae. The disclosed chisel 162 and chisel guide 150 are configured to matingly engage with each other so as to provide support and guidance for the chisel 162 during the cutting operation. Referring specificaly to FIG. 9, chisel guide 150 is similar to the chisel guide 10 and generally includes a central shelf 152 having sidewalls 154 and 156. Forward wall 158 extends around the distal end of chisel guide 150 that includes all of the structure of the previously disclosed chisel guide formed with supporting surfaces, chisel guide stops and chisel stops 194, 198. In addition, the chisel guide 150 is provided with a longitudinal protrusion 160 formed midway between the side walls 154, 156 on the center shelf 152 and extending from the proximal end towards the distal end of the chisel guide 150 where it stops short of forward wall 158. Preferably, protrusion 160 has a dovetail-like cross section (not shown) to engage a similar dovetailed shape slot 204 in the associated chisel 162. Accordingly, the chisel guide 150 is configured to slidingly receive and engage the associated chisel 162, as shown in FIG. 10. Note, either FIG. 9 or FIG. 10 needs to be rotated 180 degrees to propperly engage one another. I know you've got them oriented like this just to show all the features, maybe a line in the text is needed for clarity.
[0049] The chisel 162 for use with chisel guide 150 is substantially similar to chisel 50 and includes structure to be movably attached to chisel guide 150. Chisel 162 generally includes an elongate rectangular chisel body 164 and a distal shelf 166 extending from chisel body 164. Distal shelf 166 is formed with a distal cutting edge 168. Preferably, cutting edge 168 is tapered and arcuate as shown. Additionally, in order to provide a stop to prevent the chisel from advancing too far into onto the end plate, chisel 162 is provided with sidewalls 170 having first and second portions 172 and 174. First portion 172 includes a leight H3 corresponding substantially to the height of the chisel body 164, and second portion 174 includes a height H4 less than that of height H3. The difference in heights defines a shoulder 190 configured to engage the outer surface 8 (FIG. 1) of the vertebrae and prevent over insertion of the chisel within the vertebrae. A stop 182 is formed at the distal end of second portion 174 and is configured to engage corresponding chisel stops 198, 194 formed on chisel guide 150.
[0050] As noted above, chisel 162 includes attachment structure for slidingly engaging chisel guide 150. This structure is formed on the shelf 166 and generally includes a raised elongated guide portion 202 extending longitudinally thereon and including a dovetail-shaped recess 204. Dovetail recess 204 is configured to slidingly receive protrusion 160 of chisel guide 150. Chisel guide 150 and chisel 162 are used in a manner similarly above-described with respect to chisel guide 10 in order to chisel a pocket and prepare the end plates so that their shape and dimensions would correspond the selected sape of the known spinal implant. In addition, inner surfaces of the of the sidewalls 156, 154 of the chisel guide 150 and outer sirfaces of the sides 170 can be foremd with compementary extending grooves 208 and projections 210, as shown diagrammatically, which are confgiured to prpovide additional guidance of the chisel relative to the guide 150.
[0051] It will be understood that various modifications may be made to the embodiments disclosed herein. Therefore, the above description should not be construed as limiting the scope of the invention, but merely as exemplifications of the preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.
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Owner name: OSTEOTECH, INC., NEW JERSEY
Free format text: ASSIGNMENT OF ASSIGNORS INTEREST;ASSIGNOR:MARTZ, ERIK O.;REEL/FRAME:013771/0630
Effective date: 20030115

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Voted Best Of Delaware Twice By His Peers
Have you been the victim of a car, motorcycle or trucking accident in Delaware? Have you suffered an injury at a retail store, mall, hotel or restaurant anywhere in Delaware? Do you work in Delaware and have somehow sustained an on the job injury? Did the accident aggravate a pre-existing condition? If so, you may be entitled to various benefits and financial compensation for your medical bills, lost wages, pain and suffering (if applicable), and vehicle repair costs according to Delaware personal injury law. The exact benefits you ultimately qualify for are determined by the type of accident you were involved in, where the accident occurred and the impact the injuries had on your life. Consulting with an experienced Delaware accident attorney behooves you as they will determine the full dollar value of your claim and make all responsible parties accountable.
At The Freibott Law Firm, P.A., our Wilmington Delaware personal injury lawyers provide skilled legal representation to protect injured people and their families throughout all of Delaware including Newark, Middletown, Dover, Milford, Harrington, Georgetown and the Delaware beaches. With approximately 50 years of combined experience, our Delaware personal injury attorneys are very experienced at handling Delaware auto accident, workers' compensation and wrongful death claims. We have the experience, litigation experience and resources to obtain results.
Delaware Personal Injury Cases We Handle
Accidents resulting in physical injury, or wrongful death, don't just happen. There is typically a series of events that lead to the accident. Unfortunately, when they do occur they happen in a split second and in that time your life can be changed for years to come. Oftentimes, injury-causing accidents are the result of someone's carelessness or recklessness. Delaware Car Accident Lawyer Fred Freibott, and his associates, believe negligent parties should be held accountable for the injuries they cause. From our office in Wilmontgon our Delaware personal injury lawyers routinely handle all types of accidents including, but not limited to:
Car accidents: these cases can include rear end collisions, head-on collisions, inclement weather accidents, drunk driving accidents, drugged driving accidents and car accidents caused by eldery or inexperienced drivers.
Motorcycle accidents: many people think that there is only one type of motorcycle accident but that is not the case as we handle various types of motorcycle accidents such as single motorcycle accidents, motorcycle accidents caused by negligent driving, lane change accidents and motorcycle accidents caused by hazardous roadways.
Trucking accidents: any type of commercial vehicle can cause an accident such as tractor trailers, bus accidents, limousine accidents, taxi cab accidents, delivery truck accidents, garbage truck accidents and ambulance accidents.
Premises liability accidents: there are dozens of ways you can be injured while on someone else's property such as slipping and falling, suffering a burn, tripping on an unsecured rug or wet floor, merchandise can fall from a shelf onto you, assaults and parking lot accidents.
Workers compensation accidents: these accidents can involve work related auto accidents, chemical, thermal and liquid burns, falling, repeptitive stress injuries, machine accidents, back and neck strains, joint and connective tissue injuries, idiopathic injuries and crushing injuries. Very severe workers' comp injuries can include amputation, coma, paralysis and death.
Animal attacks: the most common type of animal attack in Delaware is a dog bite but other domestic animals can harm you as well such as snakes, cats and ferrets
Personal injury: any type of accident can result in broken bones, head injuries, brain injuries, loss of use, scarring and disfigurement, neck injuries, spinal cord injuries and amputation.
Child abuse and child injuries: injuries to chldren can be caused by abuse, neglect, sexual abuse and other types of accidents such as car accidents. Many cases of abuse, neglect and sexual abuse take place in schools, foster homes, daycare facilities, religious organizations and extracurricular activities such as boy scouts or girl scouts.
Birth injuries: include, but are not limited to, Erb's Palsy, Cerebral Palsy, suffocation and shoulder dystocia.
Who We Represent
Our Delaware personal injury lawyers represent those who have been injured in any type of automobile accident, slip and fall accident or animal attack in Delaware.
We also serve those injured at work in Delaware such as laborers, union members, healthcare workers, commercial drivers, shipping industry workers, service industry workers, teachers, poultry plant workers, construction workers, clerical workers, forklift and heavy machine operators, seasonal and part time workers.
As Delaware is bordered by several other states, and many people from out of state come to DE for school, shopping, vacation and work, we routinely handle Delaware accident, injury, workers' comp and wrongful death claims for those injured in Delaware but live in another state.
Determining Who Is Liable For Your Injuries
One of the most important aspects of a Delaware personal injury lawsuit is determining who is at fault, or liable. Depending on the type of accident there can be one liable party or multiple liable parties. Common liable parties can include your insurance carrier, the drivers insurance carrier (if you were a passenger) the other drivers' insurance carrier, third parties such as contractors, municipalities, business entities and your employer. The Delaware workers' compensation lawyers at The Freibott Law Firm will leave no stone unturned when establishing who needs to be held accountable for your injuries, missed work time and pain and suffering.
In an effort to determine the full amount of your claim we work with expert witnesses, eye witnesses and will recreate the accident scene if necessary to get you the fair and just compensation amount for your injuries.
What Benefits Can You Obtain In A Delaware Injury Case
With our decades of experience handling only accident and personal injury claims in Delaware we are very well versed in Delaware personal injury law. That includes understanding your case and how the accident impacts your life. An accident can cause you to miss work time now as well as in the future. It can also cause you years, if not a lifetime, of pain and suffering. And following the accident you may face endless medical appointments, tests and procedures, all of which can be very costly. Each of these may entitle you to various benefits, damages and financial compensation. In car accident, animal attacks and premises liability claims you may also be able to receive vehicle repair cost reimbursement, death benefits,funeral benefits and survival benefits if a loved one was killed in the accident.
What Benefits Can You Obtain In A DE Workers' Comp Case
Delaware workers' compensation benefits laws determine what benefits you receive for your workplace injury. Common benefits awarded in DE workers' comp cases are:
Medical Benefits: Per DE workers' compensation law all medical expenses such as medication costs, x-rays, surgeries, office visits, therapies and rehab efforts and hospitalization expenses are provided by the employer or the employer's insurance carrier. In Delaware the victim has the right to choose the treating physician. Effective 5/23/08, Delaware put in place a new and comprehensive Health Care Payment System (HCPS) for medical treatment.
Temporary Partial Disability Benefits: If the employee goes back to work part-time or at a lower rate than his/her pre-injury wage, the employee may be entitled to ⅔ of the difference between the pre-injury wage and his/her current wage. Partial disability may be received up to 300 weeks.
Temporary Total Disability Benefits: If there is lost time which extends beyond three days due to the injury, temporary total disability benefits become payable starting with the fourth day lost. If, however, the disability extends to seven days, the full disability period becomes compensable and no waiting period applies. The benefit amount is 66⅔ percent of gross weekly wages received at the time of the injury, up to a maximum established annually by the secretary of labor.
Permanent Impairment Benefits: When a job-related injury or illness results in a permanent partial disability, benefits are based upon a percentage of certain "scheduled" or "nonscheduled" losses. A "scheduled" loss is one involving arms, hands, fingers, legs, feet, toes, eyes, and ears. A "nonscheduled" loss is one involving the back, heart, lungs, etc.
Disfigurement Benefits: An employee may file a petition for disfigurement one year post accident/surgery for any scar, burn, or amputation related to the work accident. Disfigurement is paid out in a number of weeks up to 150 weeks, depending on the severity of the scar.
Death Benefits: When a job-related accident or illness results in the workers' death, benefits are payable to the dependents of the worker as defined by the law. The weekly benefit payments are based upon the number of dependents, but the maximum total benefit payable to all of the worker's dependents cannot exceed 80% of the maximum rate established by the secretary of labor.
Children who are deemed to be dependents remain so until the age of 18 years or if a full-time student until the age of 25 years. If a child is physically or mentally disabled he/she may be eligible for further benefits.
The employer or its insurance carrier is responsible to pay up to $3,500 in funeral expenses for a job-related death under current Delaware workers' compensation laws.
To discuss your case please contact the Delaware workers' compensation lawyers at The Freibott Law Firm for a free consultation.
What to Do During a Car Accident Insurance Claim
You should take certain steps to make sure you receive a satisfactory auto accident settlement from an insurance company, and you should avoid pitfalls that could jeopardize your claim. Below are the major "dos" and "don'ts" of Delaware car accident insurance claims.
- DO read your insurance policy as soon as you receive it, or as soon as you can after an accident. If you know what your policy covers, you put yourself in a better position to receive a fair settlement that covers all the losses for which the car insurance company is responsible.
- DO contact your own insurance carrier as soon as possible after the accident or injury.
- DO respond promptly and honestly to any insurance company's requests for information. Delaying or denying information may be seen as grounds for refusing your claim.
- DO gather as many details as you can about the accident. For example, taking pictures of any property or vehicle damage and collecting the contact information of witnesses to the accident can be invaluable in car accident settlement negotiation. Also, get the insurance information of any other person or vehicle involved in the accident.
- DO keep records of every communication you have with any insurance company, officer, or agent involved in the claim. Also, keep records of every communication with any other person involved in the claim. Each time you communicate with any of these parties, write down the date and time and summarize the communication. Keep backup copies of all written communication, like letters or emails.
- DO save receipts and bills for all expenses related to your claim. These include bills and receipts for repair work on a damaged vehicle or other property, medical treatment for your injuries, and other losses. If you're not sure whether an expense is related to your claim, save the receipt or bill just in case.
- DO review your other insurance policies to see if they cover the specific accident you were involved in. Some examples include homeowner's insurance, workers' compensation, or disability insurance.
What Not to Do During a Car Accident Insurance Claim
- DON'T volunteer information to police officers, others involved in the accident, or insurance company agents. Answer questions honestly, but stick to the facts, and never speculate.
- DON'T admit liability, even if you believe you were at fault for the accident. Fault in a Delaware car, motorcycle or trucking accident is affected by many different factors. If you admit fault, you may jeopardize your chances at a full and fair insurance settlement even if your behavior was not actually the cause of the accident.
- DON'T give any information in writing to your insurance company or any other insurance company before you have had a chance to review your policy, or while you still have questions about your policy or your claim.
- DON'T assume your insurance agent has the last word, especially when it comes to estimating the value of your claim. Do seek an injury attorney's help to estimate the value of your auto accident claim.
- DON'T sign a release or waiver of any kind. If you've been asked to sign a document and you aren't sure if it contains a release or waiver, consult with an experienced Delaware personal injury attorney for help.
- DON'T accept any payment as a full and final payment unless you are certain that the amount fairly compensates you for your losses. This is most easily accomplished by retaining a Delaware car accident lawyer handling auto accident claims throughout New Castle County, Kent County and Sussex County, Delaware.
Do I Need A Delaware Personal Injury Attorney?
Yes you absolutely do. Without an attorney protecting your rights you are almost defenseless against the insurance companies. Accidents that result in serious injuries are very traumatic and it is understandable that you would want to take the path of least resistance and accept the liable parties insurance carriers offer. This is a HUGE MISTAKE as their offer does not benefit you in any way. It is usually for a small lump sum amount that, in reality, is a fraction of the actual total dollar value of your claim. Having an experienced Delaware car accident lawyer and or a DE workers' compensation attorney in your corner ensres your rights are protected and that you will not get taken advantage of by the insurance carriers.
How Will My Injury Lawsuit Get Resolved?
Typically car accident lawsuits, personal injury lawsuits, workers compensation claims and wrongful death claims end one of two ways: settllement or verdict. While settlements account for a large majority of how accident and injury lawsuits culminate not all end that way. The accident and injury lawyers at The Freibott Law Firm we will do our best to obtain a fair and just settlement for you that includes all possible benefits and means of compensation. if the liable party or parties and Mr. Freibott cannot agree to an appropriate settlement Mr. Freibott is more than willing to take your case to the trial, also known as litigation, phase. That is one thing that separates Mr. Freibott and his associates from other accident, injury and workers' compensation attorneys is that they have a wealth of litigation experience. Let them put that experience to work for you and get you and your family the benefits you deserve.
What To Look For In A Delaware Personal Injury Lawyer
At some point in your life you may find yourself injured due to the fault of another person, party or entity. Under Delaware Personal Injury Law you may be entitled to various means of compensation and benefits depending on the extent and severity of your injuries. Left to your own devices, it can be extremely difficult for you to prove that your injuries are the direct result of someone elses carelessness or negligence. This is where the skill of an experienced Delaware Personal Injury Lawyer can be of great benefit to you. A qualified Delaware personal injury attorney will possess several key qualities that will benefit you, your family and your case. They should not only inform you of your rights but also do everything in their power to protect your rights.
When interviewing personal injury lawyers regarding handling your case there are a few qualities they should possess if they are to properly and effectively represent you. Many times it is easy to be impressed by their website, their print ads or their television and radio commercials. The attorney who spends the most money on advertising is not always the best attorney to handle your Delaware personal injury claim. Qualities you should look for when interviewing a personal injury lawyer are:
1. Experience Handling Your Type Of Claim If you were injured in a Delaware slip and fall accident hiring an attorney who specializes in Medical Malpractice claims may not be the best option for you. The term personal injury is an umbrella term that encompasses many different types of injury and accident cases that occur in many different environments. For each type of personal injury claim there are individual Delaware laws which govern the time limits for filing a claim, type of compensation you may be entitled to and benefits you may be awarded. If the attorney you are speaking with has not handled your type of case before it may not be a great idea to let them handle your case as a means of gaining experience.
2. Litigation Experience In today's legal environment a large majority of personal injury claims are settled out of court and end with a settlement. That is fine and odds are your case could end in a settlement. What you should be aware of is the fact that it could ultimately go to the litigation phase i.e. trial. If the attorney you are speaking with has never had a Delaware Slip And Fall case go to trial it may make sense to find an attorney who has had experience taking Slip And Fall cases to court. There is a huge difference in an attorney being able to negotiate a settlement on your behalf and properly representing your case in court.
3. Their History Of Obtaining Maximum Compensation And Clients For Their Clients When speaking with a prospective personal injury lawyer you should inquire about their history of getting favorable settlements and verdicts for their clients regarding the type of case that applies to you. Also, If you were injured in Delaware you should make sure you are shown settlements and verdicts for Delaware cases similar to yours. If you are speaking with an attorney who practices in multiple states the settlements and verdicts you are shown may not be apples to apples to yours. Also, please bear in mind that no personal injury case is the same as each person suffers different injuries, has different recovery times and may have had a pre-existing injury.
4. Their Professional Affiliations, Community Involvement And Legal Discipline Record The various types of professional organizations, bar associations and other groups they belong to may offer insight regarding their level or commitment to their clients and their profession. If they are involved in their community and routinely give back that can speak volumes about the type of person they are in addition to the type of attorney they are. Also, researching their disciplinary history can alert you to any professional struggles they have had over the course of their career. Much of this information can be found either on their website or by Googling their name.
5. Their History Of Handling Personal Injury Claims Sometimes attorneys can switch practice areas at any given time. Just because an attorney has been practicing law for over 20 years does not mean that they have been practicing personal injury law for that entire time. If they were estate planning lawyers until 6 months ago they most likely lack the experience to appropriately handle your claim.
Why Hire Our Delaware Personal Injury Lawyers?
In two words: We win. It is as plain and simple as that. We have a very long standing history of obtaining very favorable settlements, verdicts and judgments, for our clients.
In addition, our clients are so pleased with the results we obtain for them that they commonly thank us for not only the services we provide and the results we obtain but also for the compassion and attention to detail we demonstrate on every case.
The Freibott Law Firm is a small Wilmington, DE law firm - when you choose us to handle your case, you will come to know us personally, and we will come to know you. Our principal injury attorney is Frederick Freibott, who has over 20 years of experience practicing personal injury and workers compensation law in Delaware and helping people like you throughout Delaware. Our staff consists of legal assistants and three support staff and each are skilled at working as a team in preparing your case and keeping you informed from beginning to end.
When you leave, you will feel more relaxed. You no longer have to worry about your legal matters - that's our job.
You will know that you have an experienced, knowledgeable, and compassionate Delaware injury attorney who is going to take care of you and your case. You will have important information you will need to make effective decisions about your future, and you will feel like you are back in control.
Our goal is to give you control over what is happening in your life again. Contact us to see how we can help you.
At The Freibott Law Firm our approach is aggressive and direct when negotiating on your behalf. As our client you will see that we also very caring and compassionate and our level of customer service is impeccable. We will not waste your time. If the offer made by an insurance company is not satisfactory to adequately compensate you for your injuries and damages, we will not delay in filing a lawsuit on your behalf. We will use our expensive trial skills and courtroom experience to work in an effort to achieve for the most favorable results through litigation. With the Friebott Law Firm by your side, you can rest assured that we will work hard to protect your rights and best interests.
Regardless of whether your accident happened on the road, at work or under the care of professionals, our Delaware personal injury lawyers are ready to help you find fair and just compensation and hold negligent individuals, businesses and their insurance carriers accountable under the law in an injury accident and wrongful death claim.
Our Delaware auto accident attorneys are skilled in all aspects of case preparation and presentation, including state-of-the-art accident reconstruction. We consult with and employ an extensive network of experts who can be used in all aspects of your case. In addition, our aggressive trial work has resulted in significant awards for many of our clients. Delaware Personal Injury Attorney Frederick S. Freibott has been voted one of Delaware's Best Personal Injury Lawyers multiple times by Delaware Today. Not many other Delaware attorneys have that distinction.
To learn how we can help obtain fair compensation for your injury or loss, contact our office today to schedule a free consultation with an auto injury lawyer. Dial (302) 633-9000 today. We charge no fees or costs until we successfully resolve your legal claims.
Contact Us
The Freibott Law Firm, P.A.
1711 E. Newport Pike
P.O. Box 6168
Wilmington, DE 19804
Phone: (302) 633-9000
Fax: (302) 633-9113


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The Curables
By Scott Singer
Open iTunes to buy and download apps.
★ No Ads ★ Openfeint & GameCenter ★
Get ready to make a difference…
- Easy, casual, fun game
- Cute, adorable characters to choose from
- Different backgrounds to play with
- Amazing, and relaxing background music to listen to
- Wear your favorite color bandanna to show support while you play
What people have been saying:
- "Wow, this is a surprise --- what a fun game to play."
- "By far - the newest "feel good" game of the year!"
- "If you do not love The Curable characters, then something might just be wrong with you."
Thank you for supporting The Curables.
The idea for this App stems from our passion to find a cure and make a difference. We know that every dollar helps!
You can also email us at firstname.lastname@example.com to suggest a charity that you'd like us to support.
Thank you again and have fun playing our game.
Check us out, Follow us, Tweet us, Read our Blog at www.TheCurables.com
Disclaimer: We are not a non-profit organization. We are not asking for donations. We are just telling you what we do... we give back. It is that simple.
What's New in Version 1.6
- fixed to work on new iPad
- supports hi-res background for retina display
- enhancements and minor fixes
- Category: Games
- Updated: 03 April 2012
- Version: 1.6
- Size: 18.8 MB
- Language: English
- Developer: Scott Singer
- © Copyright 2011 - All rights reserved
Compatibility: Requires iOS 4.3 or later. Compatible with iPhone, iPad, and iPod touch.


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Hotel Piet Hein
No prices found through our partners. Please contact the business directly or check some of our recommended alternatives.
How has this hotel rated in the past?
- Suites
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Historical Traveler Reviews Hotel Piet Hein Amsterdam
A most pleasant establishment
Just returned from a 5 day stint at the Hotel Piet Hein and I am anxious to return -- not only to Amsterdam but to the hotel itself. I enjoyed a most pleasant stay and thoroughly enjoyed the hotel's facilities, not to mention its location (across the street from Vondel park, a stone's throw from Museumplein and Leidseplein, and a short walk to Rembrandtplein). The accommodations were clean, modern, fashionable and quite comfortable, both physically and psychologically. The rooms are quintessential European (ie -- small), but such is life. They are utterly functional and come complete with all that you need. The complimentary breakfast each morning is a real treat (again, typically European but delicious!). The lobby is replete with flat screen monitors for web access, an array of white leather sofas for lounging and relaxing, a large bay window for viewing Vondel Park across the street, a bar with a most congenial bartender, Martin, a 42" flat screen monitor on the wall for watching television and plenty of reading material.
Now, while I'll admit that there are more luxurious hotels and more sensational hotels -- and I've been to both, I can't see any reason for staying at such when the likes of the Hotel Piet Hein are available. I will surely return.
Clean, friendly and well-located!!!!
My boyfriend and I enjoyed a 4 night stay at the Hotel Piet Hein and neither of us could fault anything about the hotel. The staff were all very friendly and approachable and the rooms were exceptionally clean and well maintained. There were always fresh, clean towels in the bathroom when we arrived back in the evening and housekeeping kept the room looking spotless! The size of both the room and the en-suite was surprising; both were more than adiquate for two adults with plenty of baggage.
The location of the hotel was excellent, we managed to visit plenty of tourist attractions and never had to catch any public transport (apart from the airport to Amsterdam)! The hotel looked over Vondelpark and it was really nice that the first thing you laid eyes on as you walked out of the doors was the park. Everything was so easy to find and we really could not have asked for more from our hotel. We made our choice from the reviews on here and I can say that it was totally the right one!
Small but perfectly formed
I stayed here in June 2004 as my base for a business conference and found the hotel to be more than acceptable. Whilst it was never a real quality hotel, I found it to be clean, quiet and good value for money when compared to other Amsterdam hotels.
My main gripe was about the superior single room I had. Whilst clean and comfortable, it was small and the single bed (no twin) was almost too small and I am of average build. I had to close my blinds for any privacy as my room was at floor level with an outside patio, which was always empty strangely enough. On the plus side, the bathroom facilities and aircon were good and the mini-safe in room was very useful.
Reception and bar staff were extremely helpful and welcoming and spoke near-perfect English. Foyer and bar area was nicely appointed. The breakfast was indeed average but there was enough to get you going in the morning. They could definitely improve on the coffee!
It is 5 minutes slow walk to the nearest tram stop and the MuseumPlein. 10 minutes slow walk from the garish night delights of LeidsPlein. You need the tram for the City Centre and Central Station unless you have your walking boots with you. This slightly removed location definitely adds to the hotel's advantage if you don't want to be bang in the middle of noisy nightlife.
Lovely hotel!
I unfortunately only had the pleasure to stay there one night. After a long transatlantic flight, it was great to stay in a quiet hotel, in a quiet area just across the street from the park. It was very easy to find and the staff was so pleasant and eager to help. As much as I love the action of the city, it's nice to have a quiet place to place your weary head at the end of the day. I would not stay anywhere else!
Wonderful hotel
My wife and I recently stayed at the Piet Hein for two nights and had an excellent time. A tram station is just a couple of blocks away making the city centre just minutes away. Many of the best museums are also just a couple of blocks away. The neighborhood seemed very safe even at night. I recommend sitting on a bench in Vondelpark (Across the street) and watching the interesting people walk by.
The rooms were rather small but average for European standards, the breakfast was average, and the room did lack a refrigerator/minibar, but was extremely clean and very modern looking. It is also on a quiet street. The front desk staff was extremely helpful with all of our questions. I would definitely stay there again. I also would avoid any hotels in the city centre, as most of it is quite shady during the night from what we could tell. This hotel is a very safe bet.
Very Pleasant
The Hotel Piet Hein, seems to have been recently redone. Fresh bathrooms, good sized, everything clean and bright. Rooms while small were what I have come to expect of European Hotels. Always be prepared that a single is indeed a single. (Twin bed)
I am 6'3 and had no problem with the extra long bed. Room was again not that big but the bright window at the end of the room made for a pleast experience.
Staff was effective, and Multilingual. In Fact spoke far better English than the hotels that I have been to in The UK. Breakfast was sufficient to get your day started with.
Close to the Major Museums.. and the Tram lines.
Americans with a Starbucks Caffiene habit be forewarned. None to be found in Amsterdam.
Hotel Piet Hein, is an excellent buy.
Very Pleased With this Hotel - Would Come Here Again!
My family and I were searching for a reasonably priced hotel in Amsterdam where all four of us could be in one room. We looked at Piet Hein's website and decided to take a gamble.
What a pleasure! Great location - across from Vondelpark, five minute walk to the museums and Leidseplein, around the corner from PC Hoofstraat, immaculate throughout, affable staff, nice hearty (free!) breakfast.
If you're looking for quiet, quality, and quaint, this is the place. We would visit here again in a heartbeat!
Definatly would make a return visit
easily accessible by tramfrom central station. Friendy, comfortable, good breakfast, definatly would return
TripAdvisor Reviews Hotel Piet Hein Amsterdam
Travel Blogs from Amsterdam
Warm Intro to Amsterdam
I had a very good nights sleep and was ready to tackle the day. I did not have a set plan other than a few things I wanted to see so I wasn't sure how the day would go. I started by having breakfast at the hotel, which was included in my room rate. There was a large buffet with rolls and pastries and sausage and bacon and little pancakes (or …
...And on foot
... Proeflokaal Wynand Fockink. We like to attend the highest-ranked bars in our visited cities, and this place did not disappoint. Opened in the early 1600s, this is Amsterdam's oldest and most prestigious bar, serving as a sort of small competitor to Bols. About fifty different types of genever are sold. When we got our chance with the bartender, we asked what he recommended, but he said he never recommended anything. Instead, he asked us what flavors we liked ...
Rembrandt and Red Lights
Day 53- I left the house early today to get to the Rijksmuseum as early as possible. I had been told to expect lines and crowds. When I got off the bus at Amsterdam central station, it was a bit disorienting. I realized that, unlike Paris, I knew nothing about the layout of Amsterdam or its public transportation. I was relieved to see that the tourist office was right across the street where I bought map and my tickets for the museum. I took the tram from there, ...
Canals and Museums
... and motorbikes can use these lanes. I think that pedestrians are allowed there too but that's not a sure thing! When you step out onto a sidewalk or road - just look everywhere - twice. These bike riders are going super fast, no helmuts, talking on mobile phones, chatting to each other, carrying groceries, or small children. Its frantic.
The canals are lovely. And its a great way to see the city..if you can work out whether you are catching a red line or an ...
Anne Frank House and Amsterdam
... Synagogue which was the only Synagogue not destroyed by the Nazis during the war. We paid a visit to the Jewish Cultural Museum as well as two memorials to the Holocaust. One was the burned out shell of a former theatre, which the Nazis used as a deportation station for their death camps as well as a memorial to commemorate the 6 ...


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A simple event calendar created for musicians but useful for anyone. Supports multi-day events, styled text, links, images, and more.
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Last Updated: 2015-3-31
Active Installs: 3,000+
1 of 2 support threads in the last two months have been resolved.
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Milwaukee Kayak Company
Thank you for visiting Milwaukee Kayak Company – offering kayak, canoe and standup paddleboard rentals on the Milwaukee River with easy access to the Menomonee and KK Rivers. Milwaukee Kayak Company (MKC) was founded in 2013 after many years of adventures and exploration on our urban water trail which includes the Milwaukee, Menomonee and KK Rivers. We are celebrating our 3rd season and look forward to seeing you on the river soon!
Current | Late Season Hours (open thru October 18th):
• Friday 10am – 6:30pm
• Saturday-Sunday 9am – 6:30pm
* all boats need to be back to our dock by 6:30pm
* closed Monday-Thursday
We have officially entered "late season" which means that daily rentals are currently available Friday, Saturday and Sunday (closed Monday-Thursday). All boats are due back to our dock by 6:30pm. We hope to remain open on weekends thru October 18th – depends on river and weather conditions.
All of our organized guided trips have been completed for the season. If you'd like to schedule a guided trip for your school group, company outing, group of campers or anyone else, please send us an email at firstname.lastname@example.com and we'll respond with details.
Can we launch personal watercraft from MKC?
We cannot launch personal watercraft from our location because we are located on private property. Click here to find the closest public kayak launches, thanks for your understanding.
What should we bring when kayaking with MKC?
We receive lots of questions about what people should bring when they rent kayaks from us. Our suggestion is to keep it simple – and keep it smart. Breathable clothing, simple footwear and bottled water are great starters. Read more here.
Thanks for visiting our website. Please check back for updates and connect with us on Facebook, Twitter and Instagram. #MKC #milwaukeekayak #paddleonmilwaukee
Press Room
We have had the opportunity to meet and paddle with many great people at Milwaukee Kayak Company – both locals looking to explore our city and tourists looking for an urban adventure. Many have shared their experience with the world and we give many thanks for paddling with us and for showing their love for our urban water trail and great city of Milwaukee. Visit our Press Room to read their stories!


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Editorial: President's words ring locally
Transcending the miles, Southwest Florida was very much a part of the inauguration in Washington, D.C.
There seemed to be more local residents attending the festivities than in years past. Or maybe those making the trip were simply more excited and ready to tell the world.
When President Barack Obama outlined his vision for the economy, health care, energy, education and accountability, and the setting aside of partisanship for the sake of partisanship, he was speaking of issues as much on the front burner locally as they are nationally and globally. We're with him on global diplomacy as well.
To be sure, Collier and Lee counties and the rest of Florida sensed the historic nature of what was unfolding. That was in evidence at local events commemorating Martin Luther King Jr. Day only 24 hours earlier. Crowds seemed bigger and more enthusiastic. Crowds were more diverse.
That also was true of the ages, colors and new voices of the local contingent to the nation's capital.
Remake America? Sign up Southwest Florida, where innovation already is in the wind, with higher education as a key partner. Gone are the days, at least for now, when the Southwest Florida economy and the national scene are separate and apart. They are one and the same and in need of change.
Now, with hoopla and ceremony aside, we look for Obama to continue what worked so well for his campaign — clarity and urgency. Against the backdrop of the Bush administration, leadership is what we most need right now.
Obama's inaugural speech made clear a patriotic and fiscal point, that government cannot get all of the big job done. That is where the people and their spirit — this country and this region's greatest asset — come in.
Southwest Floridians have a stake in his success. We wish him well as the work begins in earnest.
Like Obama himself, Southwest Florida has come a long way to be what it is today — and both have much work ahead to restore the flame of productivity and prosperity. That, too, would make history.
Subscribe to the Naples Daily News
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Monday-Friday: 6am-6pm / Saturday: 7am-3pm / Sunday: 7am-2pm


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shneaky_kid posted Chapter 12: The New Girl to Fireflies
I write to create the reality I want to see.
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Social data: 18.9K reads. 556 votes. 147 comments.
Description: Aryah and Sage get closer.
roadsides dedicated Just Shoot - [1] Kaiya to shneaky_kid
Just Shoot
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fghor003 posted a message to shneaky_kid
hii when will you update on fireflies? plss update soon
taking down Hello Heart for some re-vamping/polishing! still working on Fireflies. :)
shneaky_kid commented on Fireflies - Chapter 11: Stay
@cupcakery7 : aryah's eyes are brown like the color of whiskey. sage's eyes are blue...like the sky.
Because I'm thankful for the little break I was given and thankful to you, dear readers, I give you a juicy Chapter 11.
shneaky_kid posted Chapter 11: Stay to Fireflies
chapter 11 is titled, "Stay". Coming soon. :)


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updated 02/01/2012 AT 10:00 AM ET
•originally published 02/01/2012 AT 10:25 AM ET
Soul Train creator Don Cornelius was found dead Wednesday morning in his Sherman Oaks, Calif., home. He was 75.
He "died from an apparent self-inflicted gunshot wound to the head," L.A. Coroner Assistant Chief Ed Winter tells PEOPLE. "Earlier this morning, paramedics had responded to his L.A. residence at the 12,600 block of Mulholland Drive. He was transported to the emergency room at Cedars-Sinai Hospital, where he was pronounced dead at 4:56 a.m. An investigation is ongoing."
According to Los Angeles Police Department spokeswoman Sara Faden, Van Nuys police officers responded to his home at 4 a.m. "Mr. Cornelius was transported to the hospital where he was declared deceased," she tells PEOPLE. "Our detectives are still on the scene."


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Narrow your search
Kobo has finally launched an e-reading app for tablets, notebooks and desktops running the Windows 8 operating system.
Apple's reading app sports a clean interface, solid controls, and a well-stocked iBookstore for all your reading needs.
Clothing brand Uniqlo has a new feature: a brain-wave-reading device that will pick a T-shirt based on your mood. But does it work? CNET's Nic Healey decided to investigate.
A chip implanted in new cards is designed to stop cybercrime. Starting Thursday, stores that haven't upgraded their card-reading terminals will be on the hook for fraudulent charges.
The software giant will invest $300 million in a new Barnes & Noble subsidiary, giving it a 17.6 percent equity stake in the company. The Nook digital bookstore will be bundled with Windows 8.
A new report finds that e-book owners tend to be more avid readers and book buyers both in print and digital mediums.
Do you spend more time deleting messages than reading them? Use these two Gmail features to tidy up.
First Entitle, now Oyster. What's a fan of the Netflix-for-e-books model to do? Thankfully, there are a few other options.
Technically Incorrect: A Japanese man, said to be drunk, decided to take out his frustrations on a Pepper emotion-reading robot belonging to telecom company Softbank.
The Kindle Paperwhite gets an HD screen, and while it isn't as big an upgrade as you'd think, it's a welcome addition, incrementally enhancing the Kindle reading experience.


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All first year students are required to take the list of courses below under 1L Required Courses. After completing the first year curriculum, students may take the remaining required courses and electives in any order they wish, subject to course prerequisites. Students also are required to take an elective course that satisfies the law school's upper level writing requirement.
First Year Required Courses
Civil Procedure I
Civil Procedure II
Contracts I
Contracts II
Criminal Law
Lawyering Skills
Legal Writing I
Legal Writing II
Torts I
Torts II
Upper Level Required Courses
Business Associations
Constitutional Law I
Constitutional Law II
Criminal Procedure
Property I
Property II


text: The Eclat hotel in Beijing as no competitor. It is part of the striking Parkview green development and feature a multitude of contemporary artworks from master like Dali as well as outstanding famous Chinese artists.It has cutting-edge rooms with all the most advance amenities. Placing a strong emphasis on attentive services this hotel has become the talk of the town.If you like fashion and if you consider yourself as trendy this is the only place in Beijing where you can enjoy contemporary art, design and hospitality.


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Award-winning home designed by Todd Rice, decorated and appointed by Don Connelly of AREA, and built by Corbel Custom Homes as personal residence. One of the best lots in Sandalwood on quiet street with huge backyard. Mahogany doors & windows, slate roof, re-claimed wide-plank French oak floors. Antique beams. Re-claimed limestone countertops. Venetian plaster. Hand painted tile kitchen backsplash. Re-claimed European mantel. Pecky Cypress panelled Dining Room. Marble Master Bath.
Request home value from the selling agent and brokerage who have participated in this transaction.


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Keds Champion Sneaker - Womens
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Item # 173318
The quintessential canvas sneaker that everyone knows, the Keds® Champion is a footwear staple and this one boasts bright color. This classic shoe looks great with everything from jeans to dresses, capris to shorts.
- Canvas upper
- Cotton terry lining
- Arch support for added comfort
- Rubber sole
- Imported
- View more Keds
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